Journal of Clinical Images and Case Reports

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Clinical Image, J Clin Image Case Rep Vol: 1 Issue: 2

Widened Lippe’s Loop Sign

Charul Dhakad1* and Anshul Kumar Gupta2

1Department of Obstetrics & Gynecology, SMS Medical College & Hospitals, Jaipur, India

2Consultant Interventional Cardiologist, Department of Cardiology, Heart & General Hospital, Jaipur, India

*Corresponding Author : Charul Dhakad
Department of Obstetrics & Gynecology, SMS Medical College & Hospitals, Jaipur, Rajasthan, India
Tel: +91 96116 18601
E-mail: [email protected]

Received: September 13, 2017 Accepted: September 25, 2017 Published: October 02, 2017

Citation: Dhakad C and Gupta AK (2017) Widened Lippe’s Loop Sign. J Clin Image Case Rep 1:2.

Keywords: Lippe’s loop; Intrauterine contraceptive device; IUD; Widenend loop sign

Introduction

A 62 years lady with diabetes and hypertension presented to emergency room with anginal chest pain of 8 hours duration. Clinical examination was unremarkable except for tachycardia. Electrocardiogram showed Acute Anterior wall myocardial infarction. Her coronary angiogram revealed triple vessel atherosclerotic coronary artery disease. During fluoroscopy, a Lippe’s loop and a copper-T Intrauterine contraceptive device (IUD) were incidentally seen (Figure 1). She recalled insertion of Lippe’s loop around 45 years back. Lippe’s loop was seen misplaced to left side with marked widening of its loops.

Figure 1: In situ Copper-T contraceptive device and displaced Lippe’s loop device with widened inter-loop distance.

Ronald L Eisenberg in 1972 described “widened loop sign” as a preemptive radiological sign of uterine perforation [1]. In 1985, production and marketing for Lippe’s loop were stopped and these devices are uncommonly encountered in current clinical practice [2]. Perforations may present acutely with severe abdominal pain or later with dysfunctional uterine bleeding, secondary infertility, or infection [3,4]. However uterine perforationmay remain asymptomatic as well, for years [5]. Widened loop sign helps us to suspect uterine perforation. While the distance between loops is usually 5 mm or less inside uterus (due to small cavity size), it gets widened to its normal configuration of about 1 cm if the device gets displaced outside the confines of uterine cavity. Later on, patient’s workup revealed Cervical intraepithelial neoplasia and she underwent total abdominal hysterectomy with difficult removal of Lippe’s loop adhered near sigmoid colon.

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